Payer policies › CPT 7208472084 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 72084 Payer coverage policies that name 72084 72084 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Hyperbaric Oxygen Therapy (HBOT) (0172) listed, no stance Apr 21, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in WV.
AZ: $31.31 (asc), effective Oct 1, 2026 CO: $16.41 (chp_plus, non-facility), effective Jul 1, 2026 FL: $11.56 (radiology), effective Jan 1, 2026 IL: $63.13 (practitioner), effective Apr 1, 2024 IN: $75.18 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $69.78 (asc, facility), effective Jan 1, 2016 KY: $55.68 (asc), effective Jan 1, 2026 LA: $30.11 (lab_radiology), effective Jul 1, 2025 MA: $78.60 (physician_radiology), effective May 1, 2024 MS: $45.37 (comprehensive, facility), effective Oct 1, 2025 ND: $88.24 (physician), effective Aug 1, 2026 NE: $78.14 (physician, non-facility), effective Jul 1, 2026 NY: $24.54 (ordered_ambulatory), effective Jul 24, 2026 OH: $60.34 (physician), effective Jan 1, 2024 OK: $17.74 (physician, non-facility), effective Jul 1, 2026 TX: $131.99 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025 VA: $68.29 (medical, facility), effective Jul 1, 2026 VT: $81.18 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $61.34 (physician, facility), effective Jul 1, 2026 WY: $46.23 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.